NHS kicks off the election debate

It is hoped that policy debates leading up to this year's general election will be more sophisticated than which party spends more on the NHS. As John Appleby argues (Come off it, Dr Cameron, 5 January), and reflected in recent correspondence in the Guardian about educational inequalities, tackling health inequalities is not just about spending more on shiny new GP surgeries but requires comprehensive approaches embracing housing, population density, the quality of the natural and built environment, progressive taxation and educational opportunities.

As recent research from the Human City Institute demonstrates, the difference in life expectancy between the inner city and the leafy suburbs can be as much as 12 years in cities like Birmingham; this cannot be tackled by redeployment of NHS resources. The nature and extent of inequality in the UK should consequently be the essential battleground upon which the general election is fought. Creating a more equal society and sustainable economy should be at the core of forthcoming debates and not hidden behind less precise terms like "social mobility" and "the aspirational society".

• Dave Cameron's supposed commitment to the NHS would be more convincing if he hadn't totally failed to reprimand his leading MEP Daniel Hannan, who twice went to the US last year to publicly denounce the NHS in the most objectionable terms. Cameron has also apparently engaged Hannan in contributing to the Tories' election manifesto, which suggests, yet again, that there are two faces to the Tory leader.

Norman Evans

East Horsley, Surrey

• Polly Toynbee writes (This death-wish brigade will let Brown crash his party, 1 January): "They [Labour] have learned nothing from the destructive plethora of pointless NHS reorganisations, leaving feeble primary care trusts as linchpin commissioners in a muddled market; the same applies to foundation hospitals". NHS foundation trusts, which only exist in England, are a worthwhile attempt to democratise one of the largest employers in the world with its necessary large budget.

Having elected governors representing users of services, public governors and staff governors, as well as appointed stakeholder governors representing various interests, including councillors, is an innovative way to plug the democratic deficit in governing the NHS at local level. Foundation trusts are are answerable to Monitor for their governance, and the Care Quality Commission for their clinical quality. The board or council of governors, representing patients and taxpayers, has a direct input in the decisions made by the board of directors, who have the legal responsibility for the trust's decisions.

When the governance of a foundation trust works well for the benefit of patients (and taxpayers), this can hardly be described as "feeble". Whichever party or parties form the next government, it would unwise to dispense with this interesting and valuable experiment in public sector accountability.

Peter Dorr

Boston, Lincolnshire

• Once again the high cost of alcohol harm on our health service has been highlighted, with research by centre-right thinktank Policy Exchange estimating that the NHS will face a £23m bill as a result of alcohol-related admissions during the New Year celebrations (Report, 31 December)

Policy Exchange suggests that this cost should be defrayed by forcing individuals to pay for their stays in hospital as an "alcohol awareness lesson". While their suggestions may find some populist resonance, such moves could be the thin end of the wedge, with smokers targeted next as being the cause of their cancers and obese people similarly labelled as "undeserving" recipients of healthcare.

While people should take more responsibility for their actions, and be encouraged to do so, surely the real issue here is to look at the environment in which such harms are occurring. With alcohol, for example, the over-availability of cheap supermarket booze is having a massive effect on increasing consumption.